A sprain is a stretch and/or tear of a ligament (a band of fibrous tissue that
connects two or more bones at a joint). One or more ligaments can be injured at
the same time. The severity of the injury will depend on the extent of injury
(whether a tear is partial or complete) and the number of ligaments involved.

A strain is an injury to either a muscle or a tendon (fibrous cords of tissue
that connect muscle to bone). Depending on the severity of the injury, a strain
may be a simple overstretch of the muscle or tendon, or it can result from a
partial or complete tear.

What Causes a Sprain?

A sprain can result from a fall, a sudden twist, or a blow to the body that
forces a joint out of its normal position and stretches or tears the ligament
supporting that joint. Typically, sprains occur when people fall and land on an
outstretched arm, slide into a baseball base, land on the side of their foot, or
twist a knee with the foot planted firmly on the ground.

Where Do Sprains Usually Occur?

Although sprains can occur in both the upper and lower parts of the body, the
most common site is the ankle. More than 25,000 individuals sprain an ankle each
day in the United States.

The ankle joint is supported by several lateral (outside) ligaments and medial
(inside) ligaments (see fig. 1). Most ankle sprains happen when the foot turns
inward as a person runs, turns, falls, or lands on the ankle after a jump. This
type of sprain is called an inversion injury. The knee is another common site
for a sprain. A blow to the knee or a fall is often the cause; sudden twisting
can also result in a sprain.

Sprains frequently occur at
the wrist, typically when people fall and land on an outstretched hand. A sprain
to the thumb is common in skiing and other sports. This injury often occurs when
a ligament near the base of the thumb (the ulnar collateral ligament of the
metacarpo-phalangeal joint) is torn.

What Are the Signs and Symptoms of a
Sprain?

The usual signs and symptoms include pain, swelling, bruising, instability, and
loss of the ability to move and use the joint (called functional ability).
However, these signs and symptoms can vary in intensity, depending on the
severity of the sprain. Sometimes people feel a pop or tear when the injury
happens.

Doctors closely observe an injured site and ask questions to obtain information
to diagnose the severity of a sprain. In general, a grade I or mild sprain is
caused by overstretching or slight tearing of the ligaments with no joint
instability. A person with a mild sprain usually experiences minimal pain,
swelling, and little or no loss of functional ability. Bruising is absent or
slight, and the person is usually able to put weight on the affected joint.

A grade II or moderate sprain is caused by further, but still
incomplete, tearing of the ligament and is characterized by bruising, moderate
pain, and swelling. A person with a moderate sprain usually has more difficulty
putting weight on the affected joint and experiences some loss of function. An x
ray may be needed to help the health care provider determine if a fracture is
causing the pain and swelling. Magnetic resonance imaging is occasionally used
to help differentiate between a significant partial injury and a complete tear
in a ligament, or can be recommended to rule out other injuries.

People who sustain a grade III or severe sprain completely tear or rupture a
ligament. Pain, swelling, and bruising are usually severe, and the patient is
unable to put weight on the joint. An x ray is usually taken to rule out a
broken bone. When diagnosing any sprain, the provider will ask the patient to
explain how the injury happened. He or she will examine the affected area and
check its stability and its ability to move and bear weight.

When To See a Doctor for a Sprain

You have severe pain and cannot put any weight on the
injured joint.

The injured area looks crooked or has lumps and bumps
(other than swelling) that you do not see on the uninjured joint.

You cannot move the injured joint.

You cannot walk more than four steps without significant
pain.

Your limb buckles or gives way when you try to use the
joint.

You have numbness in any part of the injured area.

You see redness or red streaks spreading out from the
injury.

You injure an area that has been injured several times
before.

You have pain, swelling, or redness over a bony part of
your foot.

You are in doubt about the seriousness of the injury or
how to care for it.

What Causes a Strain?

A strain is caused by twisting or pulling a muscle or tendon. Strains can be
acute or chronic. An acute strain is associated with a recent trauma or injury;
it also can occur after improperly lifting heavy objects or overstressing the
muscles. Chronic strains are usually the result of overuse: prolonged,
repetitive movement of the muscles and tendons.

Where Do Strains Usually Occur?

Two common sites for a strain are the back and the hamstring muscle (located in
the back of the thigh). Contact sports such as soccer, football, hockey, boxing,
and wrestling put people at risk for strains. Gymnastics, tennis, rowing, golf,
and other sports that require extensive gripping can increase the risk of hand
and forearm strains. Elbow strains sometimes occur in people who participate in
racquet sports, throwing, and contact sports.

What Are the Signs and Symptoms of a Strain?

Typically, people with a strain experience pain, limited motion, muscle spasms,
and possibly muscle weakness. They can also have localized swelling, cramping,
or inflammation and, with a minor or moderate strain, usually some loss of
muscle function. Patients typically have pain in the injured area and general
weakness of the muscle when they attempt to move it. Severe strains that
partially or completely tear the muscle or tendon are often very painful and
disabling.

How Are Sprains and Strains Treated?

Reduce Swelling and Pain

Treatments for sprains and strains are similar and can be thought of as having
two stages. The goal during the first stage is to reduce swelling and pain. At
this stage, health care providers usually advise patients to follow a formula of
rest, ice, compression, and elevation (RICE) for the first 24 to 48 hours after
the injury (see the box below). The provider may also recommend an
over-the-counter or prescription nonsteroidal anti-inflammatory drug, such as
aspirin or ibuprofen, to help decrease pain and inflammation.

For people with a moderate or severe sprain, particularly of the ankle, a hard
cast may be applied. This often occurs after the initial swelling has subsided.
Severe sprains and strains may require surgery to repair the torn ligaments,
muscle, or tendons. Surgery is usually performed by an orthopaedic surgeon.

It is important that moderate and severe sprains and strains be evaluated by a
health care provider to allow prompt, appropriate treatment to begin. This box
lists some signs that should alert people to consult their provider. However, a
person who has any concerns about the seriousness of a sprain or strain should
always contact a provider for advice.

Begin Rehabilitation

The second stage of treating a sprain or strain is rehabilitation, whose overall
goal is to improve the condition of the injured area and restore its function.
The health care provider will prescribe an exercise program designed to prevent
stiffness, improve range of motion, and restore the joint's normal flexibility
and strength. Some patients may need physical therapy during this stage. When
the acute pain and swelling have diminished, the provider will instruct the
patient to do a series of exercises several times a day. These are very
important because they help reduce swelling, prevent stiffness, and restore
normal, pain-free range of motion. The provider can recommend many different
types of exercises, depending on the injury. A patient with an injured knee or
foot will work on weight-bearing and balancing exercises. The duration of the
program depends on the extent of the injury, but the regimen commonly lasts for
several weeks.

Another goal of rehabilitation is to increase strength and regain flexibility.
Depending on the patient's rate of recovery, this process begins about the
second week after the injury. The provider will instruct the patient to do a
series of exercises designed to meet these goals. During this phase of
rehabilitation, patients progress to more demanding exercises as pain decreases
and function improves.

The final goal is the return to full daily activities, including sports when
appropriate. Patients must work closely with their health care provider or
physical therapist to determine their readiness to return to full activity.
Sometimes people are tempted to resume full activity or play sports despite pain
or muscle soreness. Returning to full activity before regaining normal range of
motion, flexibility, and strength increases the chance of reinjury and may lead
to a chronic problem.

The amount of rehabilitation and the time needed for full recovery after a
sprain or strain depend on the severity of the injury and individual rates of
healing. For example, a mild ankle sprain may require up to 3 to 6 weeks of
rehabilitation; a moderate sprain could require 2 to 3 months. With a severe
sprain, it can take up to 8 to 12 months to return to full activities. Extra
care should be taken to avoid reinjury.

RICE Therapy

Rest
Reduce regular exercise or activities of daily living as needed. Your health
care provider may advise you to put no weight on an injured area for 48
hours. If you cannot put weight on an ankle or knee, crutches may help. If
you use a cane or one crutch for an ankle injury, use it on the uninjured
side to help you lean away and relieve weight on the injured ankle.

Ice
Apply an ice pack to the injured area for 20 minutes at a time, 4 to 8 times
a day. A cold pack, ice bag, or plastic bag filled with crushed ice and
wrapped in a towel can be used. To avoid cold injury and frostbite, do not
apply the ice for more than 20 minutes.

Compression
Compression of an injured ankle, knee, or wrist may help reduce swelling.
Examples of compression bandages are elastic wraps, special boots, air
casts, and splints. Ask your provider for advice on which one to use, and
how tight to safely apply the bandage.

Elevation
If possible, keep the injured ankle, knee, elbow, or wrist elevated on a
pillow, above the level of the heart, to help decrease swelling.

Can Sprains and Strains Be Prevented?

There are many things people can do to help lower their risk of sprains and
strains:

Vitamin C (250 to 500 mg two times a day) is
important for keeping collagen, ligaments and tendons strong. It helps
reduce swelling, repair tissue, support connective tissue and promote proper
healing.

Omega-3 fatty acids can help reduce inflammation
which is important for strains and sprains.

Bromelain (250 to 500 mg three times a day between
meals) can help reduce swelling.

Turmeric (250 to 500 mg three times a day between
meals). If taken with bromelain, it can make the effect of bromelain
stronger.

Zinc (15 to 30 mg a day) promotes wound and tissue
repair and is very important for bone health.

Be sure get enough protein in your diet

Calcium (1,000 mg a day)and
magnesium (500 mg a day) are very important for bone and muscle health.

There are some very good Chinese herbal patent formulas
that help reduce inflammation and swelling and promote healing:
Jin Gu
Die Da Wan

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